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CDC releases guidance on caring for ‘COVID long-haulers’

Thousands of patients have reported experiencing a wide range of physical and mental health consequences that persist after a COVID-19 infection. Patients with post-COVID-19 conditions, sometimes referred to as “COVID long-haulers,” often experience issues four or more weeks after being infected with the virus. Many of these patients routinely seek medical treatment for relief of their symptoms.

In an effort to help clinicians care for these patients, CDC released interim guidance on the evaluation and management of patients with post-COVID-19 conditions or “long COVID.”

After a COVID-19 infection, patients may feel like they are “tired for monthsand months, [and] shortness of breath goes right along with that,” said Chris Bland, PharmD, BCPS, FIDSA, FCCP, a clinical professor at the University of Georgia College of Pharmacy, during a May 13 APhA webinar on addressing the COVID-19 crisis. “A lot of these patients, as we know, have other comorbid conditions, which this disease obviously can worsen.”

The occurrence of post-COVID-19 conditions has varied, with some reports citing as little as 5% and others 80% of long-term symptoms and conditions following a COVID-19 infection. Post-COVID-19 conditions can occur in children, adolescents, and adults, and little is known if certain groups are at a higher risk compared with others. The symptoms that manifest after a COVID-19 infection are heterogenous and can range from shortness of breath to cardiac conditions to neurological effects, among others.

For patients who were hospitalized with COVID-19, CDC recommends in the new guidance that patients be seen for a follow-up visit within 1 to 2 weeks of hospital discharge. For those who experienced asymptomatic infection to moderate illness and were not hospitalized, CDC said these patients could benefit from a follow-up visit 3 to 4 weeks after their initial infection if they experienced ongoing or new symptoms.

A thorough past medical history, social history, and comprehensive physical examination should be taken as part of the evaluation, along with a basic panel of laboratory tests (e.g., CBC, LFTs, TSH/T4, etc.) to assess for conditions that may respond to treatment.

CDC noted that, at this time, no laboratory test can definitively distinguish post-COVID-19 conditions from other etiologies, in part due to the heterogeneity of post-COVID-19 conditions.

More specialized diagnostic testing may also be needed in the context of the patient’s symptoms (e.g., testing for rheumatological conditions in patients experiencing arthralgias).

Functional testing may also be helpful to quantitatively document clinical status over time (e.g., Post-COVID-19 Functional Status Scale, Mini Mental Status Examination for those with neurological conditions, Fatigue Severity Scale, etc.). 

In the new guidance, CDC noted that optimizing patient function and quality of life should be the focus for clinicians. They remind clinicians that there is no one-size-fits-all approach, and a treatment plan should always be customized to the patient’s conditions and treatment goals.

 

Maria G. Tanzi, PharmD, contributing writer. Tanzi is an employee of Incyte Corporation. The opinions expressed in this article are those of the author and do not represent the views of Incyte. 

For the full article, please visit www.pharmacytoday.org for the September 2021 issue of Pharmacy Today.

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